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Shrimp allergic patients are most likely at risk of food allergy to mealworm and other insects. Primary mealworm allergy does not mean subjects are likely to react to all insects.

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The growing world population motivates the exploration of new sustainable protein sources to ensure food security. Insects such as mealworm (Tenebrio molitor) are promising candidates, with active ongoing marketing efforts within America and Europe. This warrants assessment of the potential risks. Toxicologic and microbiological risks were assessed previously, 1,2 but not the potentially allergenic risks. Pilot results 3 suggest that shrimp-allergic patients might be at risk for mealworm allergy because IgE binding to tropomyosin and arginine kinase (major shellfish allergens) and sarcoplasmic calcium-binding protein and myosin light chain (minor shell fish allergens) was detected. Our aim was to investigate the allergic potential of mealworm in the shrimp-allergic population. Fifteen from 60 adult patients from the University Medical Center Utrecht with shrimp allergy based on specialist opinion and diagnostic testing were included in this double-blind, placebocontrolled food challenge (DBPCFC) trial, after testing positive in ImmunoCAP, skin prick test, basophil activation test, or immunoblot (see this article's Online Repository at www.jacionline.org). All subjects gave written informed consent before participation. The study was approved by the local ethics committee (NL43731.041.13). Patients' median age was 38 years (range, 19-69 years), and 47% were men. Symptoms by history ranged from oral symptoms

Thermal processing did not lower allergenicity but clearly changed solubility of mealworm allergens. A sequential extraction method allowed for assessment of a broader protein panel.